kappa league application_2012-13 final

7/27/2019 Kappa League Application_2012-13 Final

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FLA Kappa League Membership Application

Academic Information

Academic Honors

List scholastic distinctions you have won since the 7 th grade (i.e. honor roll, National Merit, etc.)

Activities (check all that apply)

Please list your hobbies, interests, community service, sports, musical, art and/or extracurricular activities.

Performing Arts: Sing Dance Act Musical Instrument- Type:

Sports:Basketball Baseball Track Tennis Golf Football Swimming

Fencing Lacrosse Wrestling Other:

Hobbies, Club Activities and/orCommunity Involvement:

Aspirations

What are your career ambitions?

List colleges/ universities you are presently interested in attending:

1. 2.

3. 4.

School Name (2012-13):

School Address:

City, State Zip Code

Are you involved in StudentGovernment? If so, list your office?

Courses enjoyed the most

Courses most challenging




Letter of Interest

Provide a one-page, typed essay, incorporating the highlighted points below (based on your level of membership). You may also includany information about yourself that you deem to be important or special.

New Member: Listed are points to consider in your essay:

1. Why are you interested in Kappa League?2. What do you hope to gain from being a part of FLA Kappa League?3. What qualities or attributes would you bring to FLA Kappa League?

Returning Member: Listed are points to consider in your essay:

1. What knowledge have you gained from being a part of FLA Kappa League ?2. How do you plan to make an impact in FLA Kappa League this upcoming year?

Complete the SMART goals chart. Remember, a goal is a promise you make yourself.

S M A R TMeasureable Achievable Relevant Time-Bound

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possible.

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goal.

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Academic

Personal

Family

Financial

Physical

KappaLeague

Applicant Acknowledgement

I wish to participate in the F LA Kappa League. I promise to be careful to prevent damage to any property that may be used while

participating in activities with the F LA Kappa League. I also agree to obey the rules of the F LA Kappa League, and that anytim

I can/will be expelled from the F LA Kappa League for conduct that is detrimental to the program.

Applicant Signature __________________________________ Date: ____________




Release for Medical Treatment

In the event of an emergency and the inability of the FLA Kappa League Advisors to obtain my consent, I hereby give permission

for FLA Alumni Chapter of Kappa Alpha Psi Fraternity, Inc., to authorize any medical treatment or surgery in which a qualified

physician or surgeon shall deem prudent for my child.

Parent/Guardian Signature: _____________________________ Date: ____________

Parent/Guardian Signature: _____________________________ Date: ____________

In case of an emergency, which hospital or urgent care do you prefer to have your child transported?

Hospital/Urgent Care Facility: _____________________________________________

Primary Care Physician's Name: ____________________________________________

Parental Acknowledgment

I hereby give permission for my child to participate in the FLA Kappa League. I understand that FLA Alumni Chapter of

Kappa Alpha Psi Fraternity, Inc., is not responsible for personal injury or loss of property. I understand that my child is free

to leave the program at any time. I agree to immediately update this application when any information changes.

Parent/Guardian Signature: ___________________________ Date: ____________


Photo Release

I give permission to FLA Alumni Chapter of Kappa Alpha Psi Fraternity, Inc., to use or release any photos of my child

taken for the purpose of promoting the Fraternity and its Guide Right Program.



FLA Kappa League Advisory Committee – Internal Use:

Applicant: Returning New

Application: Complete Incomplete

Interview: Exceptional Satisfactory Unsatisfactory N/A

Committee Recommendation: Applicant Accepted Applicant Declined

Mentor Assignment:

kappa league application_2012-13 final

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